As a psychotherapist in training, I was used to uncertainty. So, when Eddie*, a prospective patient, said to me, “I want to work with someone who doesn’t know what he’s doing,” I was okay with being confused. However, I didn’t know how to help.
Previously, I had been consulted for reasons that appeared practical: I was cheaper—about half the price of a licensed professional; and I was flexible, with evening and weekend hours. But I had never earned a patient because of incompetence.
So I asked, why not work with someone who knows what he’s doing?
“I can afford it,” Eddie said, “but I don’t want to change. I just want to be listened to.”
I paused, unsure how to respond. My role, as I understood it, was to help him change.
Eddie laughed. He looked up and our eyes met. I felt a strong pull to join him.
“Sorry,” he said. “I laugh a lot. I can’t help it.”
He couldn’t help laughing, and I couldn’t help him. So I joined him. I held eye contact and allowed a smile. Within seconds, I, too, was laughing.
Though humor has a small mark on the history of psychotherapy, it deserves more attention. In the last fifty years, humor—laughter  specifically—has proven integral to health .
Despite the minimal attention, Freud clearly valued humor as a crucial defense and one of the healthiest means of coping with suffering .
Humor results when we anticipate an emotional reaction to a trauma but instead experience something else . To deal with overwhelming suffering, the child may develop neuroses, including anxiety, depression, or humor.
Though humor forms to ensure survival, it can also cause dysfunction. Think of the child who entertains his parents to distract from fighting, only to bear the burden when they divorce. Or Robin Williams, who used humor to distract from depression, only to fall victim to suicide.
Thus, the relationship of humor and mental health is complicated, as it can sustain life, yet hinder development.
Perhaps no one has a more conflicted relationship with humor than the comedian, whose vocation demands a distorted and obsessive way of thinking. Humor becomes his bread and butter, needed not only to survive but also to thrive.
Perhaps an amount of dysfunction is necessary to function as a comedian. If so, it may not be surprising that a recent study found that comedians show more symptoms of mental illness than the average person .
To help us think about the complicated relationship between humor and mental health, let us further consider the case of Eddie.
Part I: Laugh With Me
Despite my cracking up, Eddie agreed to treatment.
He is a successful comedian in his 30s. Eddie is tall; wears bright, over-sized t-shirts; and he has a loud, yet infectious, laugh.
Eddie finds it “impossible to stop performing” and he feels guilty if he fails. Paying for an audience (ie, a therapist), he reasoned, would thwart this guilt.
In treatment, Eddie spoke of his childhood with a practiced and coherent narrative. He used humor as a way to survive a strained household—money was tight and his parents would fight daily. When he did impersonations of family members, the tension diffused. His father, a blue-collar worker, adored his older brother, a star athlete. Short on athleticism, Eddie relied on his skilled impressions to win his family’s attention.
As an adolescent, Eddie was taller than most classmates. His growing stature intimidated people, and teachers called him a bully for making fun of classmates. Driven by guilt, Eddie changed his comedic approach from making fun of others to making fun of himself, converting from a threatening to a comic figure.
Eddie has always craved structure and stability in his personal life. He was a devout Christian until recently. He married his college sweetheart at 21. He wears a uniform of t-shirt and jeans daily. He wants his spiritual, romantic, and fashion relationships “settled,” so he can focus all energies on his career.
Eddie’s job is to make people laugh. However, he thinks he serves a greater purpose: to stimulate and unify strangers. As a performer, he “merges with the audience.”
In treatment, Eddie compared comedy and psychotherapy regularly, noting that both professions observe, interpret, and ask their audiences to make new connections. Comedians and therapists also strive for “the perfect hour,” though comedians “run the light” while therapists “stop short,” ending an “hour-long” session at 50 minutes.
When receiving such observations, I felt as if Eddie was performing for me. I thought he might want me to laugh, or at least appreciate his cleverness.
“I like when you laugh,” he said. “It means you get it.”
In other words, my laughter absolved him of guilt, ensuring he was not making me angry, sad, or feel bad . Though Eddie clearly used humor to contain hate , I wondered how he expressed it.